1. Date of download: 7/11/2016 From: Estimating Overdiagnosis in Low-Dose Computed Tomography Screening for Lung Cancer: A Cohort Study Ann Intern Med. 2012;157(11):776-784. doi:10.7326/0003-4819-157-11-201212040-00005 Copyright © American College of Physicians. All rights reserved.American College of Physicians

2. Date of download: 7/11/2016 From: Estimating Overdiagnosis in Low-Dose Computed Tomography Screening for Lung Cancer: A Cohort Study Ann Intern Med. 2012;157(11):776-784. doi:10.7326/0003-4819-157-11-201212040-00005 Distribution of incident lung cancer diagnosed over the 5 years of the study, according to VDT and preoperative CT-PET. 64% of cases of cancer had a VDT <400 d. 26% were slow-growing or indolent (VDT ≥400 d). CT-PET was visually assessed as positive or negative. “Missing” indicates that CT-PET was unavailable because it was not done or was done at another hospital. CT = computed tomography; PET = positron emission tomography; VDT = volume-doubling time. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

3. Date of download: 7/11/2016 From: Estimating Overdiagnosis in Low-Dose Computed Tomography Screening for Lung Cancer: A Cohort Study Ann Intern Med. 2012;157(11):776-784. doi:10.7326/0003-4819-157-11-201212040-00005 Breakdown of lung cancer–specific mortality in cases of incident cancer, according to 2 lesion classifications. CT = computed tomography; VDT= volume-doubling time. Top. Cancer classified as new (diagnosed in follow-up but not seen on previous CT), fast-growing (arising from a previously identified nodule with a VDT <400 d), or slow-growing (arising from a previously identified nodule with a VDT ≥400 d). The single patient with slow-growing cancer who died had a history of bilateral breast cancer; death was attributed to lung cancer metastasis but was not ascertained. Results of log-rank test for new vs. fast-growing vs. slow-growing nodules (P = 0.046), new vs. fast-growing nodules (P = 0.138), new vs. slow-growing nodules (P = 0.010), and fast vs. slow-growing nodules (P = 0.132). Bottom. Cancer classified according to VDT. Log-rank test for VDT subcategories (P < 0.001). Median observation times were 4.0 y for new nodules, 3.5 y for fast-growing nodules, and 3.7 y for slow-growing nodules and 4.3 y for nodules with a VDT <50 d, 3.5 y for nodules with a VDT ≥50 and <100 d, 3.4 y for nodules with a VDT ≥100 and <200 d, and 3.7 y for nodules with a VDT ≥200 d. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

4. Date of download: 7/11/2016 From: Estimating Overdiagnosis in Low-Dose Computed Tomography Screening for Lung Cancer: A Cohort Study Ann Intern Med. 2012;157(11):776-784. doi:10.7326/0003-4819-157-11-201212040-00005 Breakdowns of lung cancer–specific mortality, according to VDT, preoperative CT-PET, and pathologic stage. CT = computed tomography; PET = positron emission tomography; VDT = volume-doubling time. Top. “Fast-growing CT-PET positive” includes new CT-PET positive nodules. “Other” comprises slow-growing CT-PET negative (n = 22), slow-growing CT-PET positive (n = 7), and fast-growing CT-PET negative (n = 28) cancer. All categories except fast-growing CT-PET positive had excellent prognoses. Log-rank test for VDT subcategories (P < 0.001). Bottom. For stage I and stages II to IV disease, a preoperative CT-PET positive nodule was a negative predictive factor. Log-rank test for preoperative CT-PET and pathologic stage (P < 0.001). Median observation times were 3.6 y for fast-growing CT-PET positive tumors vs. 3.7 y for all other tumors; 3.6 y for stage I CT-PET negative tumors, 3.6 y for stage I CT-PET positive tumors; 4.1 y for stages II to IV CT-PET negative tumors, and 4.0 y for stages II to IV CT-PET positive tumors. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians